Ethan-Ira B Mamuric, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

301131 Issued in CA

Practice address

201 N Robertson Blvd
Beverly Hills, CA 90211-1729

Phone

(424) 303-7647

NPI assigned

Oct 12, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Next Phase Medical PC

  • General Practice Physician
  • Culver City, CA
  • NPI 1821961863
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1386306736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 S DETROIT ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900363475",
            "telephone_number": "908-405-5947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N ROBERTSON BLVD",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902111729",
            "telephone_number": "424-303-7647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMURIC",
        "first_name": "ETHAN-IRA",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-12",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "301131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natasha Malkani, MD
• Moira Regina Mallach
• Jared Adam Maloff, PSY.D.
• Derek John Maloney, MD
• Lauri Andrea Malter, DDS
• Talayeh Manafzadeh Tabriz
• Management, Inc.
• Sherol Manavi, PHYSICIAN ASSISTANT
• Avner Manzoor Mandel, MD
• Mark A Mandel, M.D.

• Physical Therapist in Beverly Hills, CA
• Providers in Beverly Hills, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.